Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | MD021813E | PA |
NPI | 1275670630 |
---|---|
Provider Name | Janet Lee Wilson |
First Address | Philadelphia, PA 19146-1343 |
Second Address | Philadelphia, PA 19107-6734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C32476 | (02) | PA |